Latest news with #BharatiVidyapeethMedicalCollege
The Hindu
02-06-2025
- Health
- The Hindu
Small change in MBBS education curriculum can make substantial impact on early detection of TB: study
Tuberculosis (TB) remains one of India's most significant public health challenges, with the country accounting for nearly a quarter of the global TB burden. Despite a robust national programme and the availability of free diagnostic and treatment services under the National Tuberculosis Elimination Programme (NTEP), early detection of the disease continues to fall short. Many individuals with symptoms of TB go undiagnosed for weeks or even months, contributing to continued transmission within communities as well suffering avoidable health complications. The delays in diagnosis are often attributed not just to gaps in health infrastructure but also to a lack of early suspicion at the primary point of care. Patients commonly approach local healthcare providers with symptoms like persistent cough, weight loss, fever, or night sweats. However, these symptoms are frequently misattributed to other conditions or treated symptomatically, without considering TB as a possible cause. This widespread failure to 'suspect TB' -- a critical first step -- has been repeatedly identified as a major reason for missed cases. It is in this context that a community-based screening model was introduced at Bharati Vidyapeeth Medical College in Pune. The goal was to find a sustainable, scalable way to improve TB case detection while simultaneously integrating public health practice into the medical curriculum. The innovation came through the Family Adoption Programme (FAP), a nationwide initiative mandated by the National Medical Commission, which assigns medical students to specific rural or urban communities for continuous engagement throughout their training. The study learnings from integrating TB screening activity into FAP for MBBS students was published in Frontiers in Public Health. The first point of contact and active case finding Swathi Krishna, TB researcher and public health physician based in Pune and key faculty member behind the programme's implementation, explains the rationale, 'In our healthcare system, the first point of contact is often a missed opportunity. Students are the future of that system, so we need to train them not just in hospital-based care but in recognising the realities at the ground level.' Under this initiative, MBBS students visiting households began asking just four simple symptom-based questions related to TB. If any symptom was reported, the case was flagged and referred to the local ASHA (Accredited Social Health Activist) for follow-up and testing. This low-cost, high-reach strategy is referred to as 'active case finding', a method endorsed by the World Health Organization (WHO) and the NTEP, but rarely operationalised at scale in routine community interactions. The results were encouraging: not only did the students identify presumptive TB cases, but they also became more confident in recognising its early signs and engaging with communities on sensitive health issues. The involvement of ASHA workers was crucial. According to Dr. Swathi, 'ASHA workers are already doing so much. When students collect these symptom reports during household visits, it lightens the ASHA worker's load and makes their follow-up more targeted.' In effect, the programme bridged the gap between community-based medical education and primary care outreach, enhancing both the learning experience of students and the reach of public health services. Breaking stigma barriers through continuos awareness Sanjivani Patil, associate professor in the Department of Community Medicine, adds that the model is particularly powerful because of its continuity. 'Unlike a one-off camp, the FAP ensures that students are visiting the same families regularly over three years. This builds rapport. Initially, people are hesitant to talk about TB symptoms because of stigma or fear. But with time, they open up. They trust the students.' Stigma remains a formidable barrier. In many communities, TB is still viewed with fear and shame, leading patients to conceal symptoms or delay care. Awareness about the Nikshay Poshan Yojana—a scheme under the NTEP that provides free treatment, nutritional support, and diagnostics—is also limited. But the presence of students, guided by faculty mentors and supported by local health workers, gradually breaks down these barriers. Community engagement activities such as street plays, awareness rallies, and health talks further reinforce positive messaging and reduce misinformation. From an educational standpoint, the intervention fits seamlessly into the competency-based medical education (CBME) framework. Students are trained to communicate effectively, collect and analyse health data, and understand the social determinants of disease. Their work is assessed through logbooks and field reports, ensuring accountability. As Dr. Patil observes, 'This experience gives students a reality check. In hospitals, they see rare diseases. But in the field, it's about cough, fever, diarrhoea, and skin issues. These are the cases they will encounter as primary care physicians. They learn to think beyond the textbook.' Possibilities of expansion, challenges and further research The programme's design also allows for replication. Every medical college implementing FAP can adapt this TB symptom screening model. Each batch of MBBS students is assigned around 800 households, translating into a wide population base being covered. Urban settings are not excluded -- Urban Health Training Centres (UHTCs) affiliated with medical colleges can deploy the same approach in underserved city neighborhoods, slum areas, or industrial zones. Saibal Adhya, another senior faculty member at the college and co-author of the study, highlights the policy implications. While India's TB programme is well-resourced, he points out that treatment and testing still need to be more accessible at the grassroots level. 'Even though the services are free, the unavailability of drugs or closed diagnostic labs leads people to spend from their own pockets. That's where trust in the system erodes,' he says. He also recommends that regular faculty development sessions and workshops on NTEP guidelines be institutionalised across all medical colleges. 'You cannot expect students to be champions unless their teachers are aligned with national health priorities,' he says. Authors also point out the importance of such TB screening initiatives, as a modest change in routine educational practice can make a substantial impact on both medical training and public health outcomes. Dr Swati says, 'It reinforces the idea that meaningful change does not always require massive infrastructure or funding. Sometimes, it just takes the right questions asked at the right time by the right people.'
Time of India
18-05-2025
- Health
- Time of India
Bone marrow transplant changes two-year-old bedridden Adhiraj's life
MUMBAI: There's a reason two-year-old Adhiraj Gaikwad 's parents admitted him to a hospital in Mumbai for diarrhoea rather than a facility closer to home near Swargate in Pune. For one, Adhiraj was born with not one but two rare genetic disorders . Additionally, he underwent a bone marrow transplant to cure one of the conditions at this city hospital five months ago. On Friday, doctors at Kokilaben Ambani Hospital in Andheri said he is improving and should be discharged soon. 'As the transplant is quite recent, we have to get him here for regular checks and in case of any infection,' said his 34-year-old father, Mayur, who left his job as a marketing executive to gather funds for Adhiraj's treatment. The bone marrow transplant (BMT) cured him of one of the rare conditions called Mucopolysaccharidosis Type 1 (MPS 1), also known as Hurler syndrome or gargoylism, which affects only 10 in a million children. However, Adhiraj continues to suffer from Fanconi-Bickel Syndrome , a rare glycogen storage disease in which the body is unable to process glucose and galactose. It has no cure, and the patient can only eat a corn starch-based diet for life. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Want Lower Bills Without Changing a Thing? elecTrick - Save upto 80% on Power Bill Learn More Undo Adhiraj, who was born 28 months ago, missed developmental milestones in the first six months. 'He wouldn't roll over like other children do and seemed grossly underweight,' said his father. After visiting multiple doctors, his parents were advised by doctors at Bharati Vidyapeeth Medical College in Pune to conduct genetic tests that revealed MPS1 and Fanconi-Bickel Syndrome. Due to these conditions, the child was non-verbal, had bodily and facial deformities, along with impairment of vision and mobility, said the doctors. MPS1 was previously referred to as "gargoylism" as the children had certain facial features such as a prominent forehead, widely spaced eyes, a prominent nose, and a short neck that led to the association with mythical gargoyles. Through online support groups, the Gaikwads first went to KEM Hospital in Parel, which is a designated Centre of Excellence (CoE) for rare diseases by the union health ministry. The hospital provided the special enzyme shots for a few months but recommended a bone marrow transplant for Adhiraj. MPS1, a lysosomal storage disorder in which an essential enzyme called hyaluronidase is not produced in the body, has a low incidence of one in 100,000 live births. 'India possibly has 200 children born with this disease,' said KDAH's paediatric oncologist Dr Santanu Sen, who treated Adhiraj. Most children with MPS1 never get diagnosed. Soon after birth, they develop coarse facial features, their development gets impaired, their intelligence gets compromised, and organs such as the liver and spleen become big and their joints get stiff. 'They often suffer from infections and could get cataracts and heart problems,' said Dr Sen, adding that the children rarely survive beyond eight years. The enzyme replacement treatment that KEM offered for free to Adhiraj costs between Rs 2.2 lakh to Rs 2.5 lakh per vial. A child needs two vials per week, with the monthly treatment costing around Rs 18 lakh. 'Hence, BMTs are a good option for children with MPS1. But, worldwide, less than 100 BMTs have been for this disease,' said Dr Sen. Before Adhiraj returned to Mumbai with his current diarrhoea problem, the Gaikwads had begun noticing changes in his health. 'It's like a switch in the brain has been turned on, and suddenly the withdrawn child who wasn't moving much has changed,' said the doctor. Mayur said his son was 7.5 kg at 22 months when he underwent the BMT. 'He has put on weight, and we have been noticing a lot of change in him. He is now able to sit with support. He smiles, laughs, and interacts a lot more than before,' he added. The family has already spent lakhs on his treatment so far. 'While the social workers at KDAH helped us generate funds for the transplant, we will need finances for his rehabilitation and management of the Fanconi-Bickel Syndrome,' he added.
